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General NPI Number Information
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NPI Number | 1598905465
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Entity Type | Organization
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Legal Business Name | ST. LUKES EPISCOPAL HOSPITAL
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 03/04/2009
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Provider Practice Location Address
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Address Line | 905 POYDRAS HWY
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-7512
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Country | US
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Telephone | 337-224-1768
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Fax |
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Provider Business Mailing Address
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Address Line | 905 POYDRAS HWY
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City | BREAUX BRIDGE
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State | LA
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Zip | 70517-7512
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Country | US
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Telephone | 337-224-1768
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Fax |
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Authorized Official
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Title or Position | CRNA
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Name | MR. REGGIE MICHAEL HOLLIER
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Credential | CRNA
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Telephone | 337-224-1768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | RN107735
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License Number State | LA
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